Kelly Jay Kadolph, D.C.

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

005205 Issued in MO

Practice address

3307 Miller St
Bethany, MO 64424-2716

Phone

(660) 425-3312

Fax

(660) 425-3438

NPI assigned

Jun 17, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Specialty

Chiropractic

Education

Cleveland Chiropractic College - Kansas City, 1985

Medicare assignment

May accept Medicare assignment

Group practices

Jenny L Wiemann DC PCGroup PAC ID 3577506971, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jenny L Wiemann DCPC

  • Chiropractor
  • Saint Peters, MO
  • NPI 1245452093

  MO

  Medicare reassignment Care Compare group NPD
• Add Life Chiropractic & Wellness Center, Inc

  • Chiropractor
  • Osage Beach, MO
  • NPI 1174728950
  NPD (past)
• Guernsey Chiropractic and Sports Injury Center LLC

  • Chiropractor
  • Bethany, MO
  • NPI 1609178185
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389830400000",
    "number": "1639114366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 527",
            "city": "BETHANY",
            "state": "MO",
            "postal_code": "644240527",
            "telephone_number": "660-425-3312",
            "fax_number": "660-425-3438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3307 MILLER ST",
            "city": "BETHANY",
            "state": "MO",
            "postal_code": "644242716",
            "telephone_number": "660-425-3312",
            "fax_number": "660-425-3438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KADOLPH",
        "first_name": "KELLY",
        "middle_name": "JAY",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-17",
        "last_updated": "2014-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "MO",
            "license": "005205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "20768013",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Donna May Hurt, LCSW
• Hy-Vee Inc
• Infinity Health
• Dillon Wesley James, PHARMD
• Kadolph Chiropractic Clinic PC
• Taya Kirk
• Kenneth Chad Lambert, D.O.
• Laura L. Lane, L.C.S.W.
• Tamula K Maxwell, PA-C
• McCall Family Dentistry

• All providers in Bethany, MO
• Sports Physician Chiropractor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.